Implementation Guide for the Nursing Management Minimum Data Set: NMMDS

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

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... 10 NURSING MANAGEMENT MINIMUM DATA SET NMMDS... 11 Environment... 11 Nurse Resources... 11 COMPONENT - ENVIRONMENT... 12 01 Facility Unique Identifiers... 12 02 Type of Nursing Delivery Unit/Service... 13 03 Patient/Client Population... 25 04 Volume of Nursing Delivery Unit/Service... 28 05 Care Delivery Structure and Outcomes... 35 06 Patient/Client Accessibility... 36 10 Accreditation/Certification/Licensure... 39 COMPONENT - NURSE RESOURCES... 41 13 Staffing... 41 14 Satisfaction... 48 19 Nurse Demographics per Unit or Service... 50 20 Clinical Mental work... 59 21 Environmental Conditions... 65 22 Electronic Health Record (EHR) Implementation Stages... 67 REFERENCES... 70 APPENDIX A The Nursing Management Minimum Data Set Survey... 75 APPENDIX B - Publications - NMMDS Articles Published... 99

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 2007-2015 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.

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 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 delaney@umn.edu Co-Author/Editor Initial Developers Bonnie L. Westra Lisiane Pruinelli Diane Huber Connie Delaney westr006@umn.edu pruin001@umn.edu diane-huber@uiowa.edu delaney@umn.edu Project Manager Lisiane Pruinelli pruin001@umn.edu Project team members Jung In Park Colleen Hart Lynn Choromanski Mary Jo Swanson Tylor Wagner Amar Subramanian Dorcas Kunkel Mary Jo Swanson park1025@umn.edu cmhart2@outlook.com lchoromanski@gillettechildrens.com swan0121@umn.edu tylorwagner@gmail.com informatics@comcast.net kunk0041@umn.edu mswans13@fairview.org

6 Vocabulary Facilitator Susan Matney samatney@mmm.com Project Sponsor Connie Delaney delaney@umn.edu Subject Matter Expert Amy Garcia amy.garcia@cerner.com Subject Matter Expert Barbara Caspers barbaracaspers@aol.com 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 2007-2015 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 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 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 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 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 (http:/loinc.org). 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 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 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. 01.01 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. https://nppes.cms.hhs.gov/nppes/welcome.do (Heart association, Catholic Charities) 01.12 Facility Name Legal name of the facility 01.07 Geographic location State or Territory of the facility where the service was provided or originated as defined by the United States Postal Service (http://www.itl.nist.gov/fipspubs/) 01.08 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 (http://zip4.usps.com/zip4/citytown_zip.jsp). 01.10 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). (http://www.cms.hhs.gov/placeofservicecodes/downloads/placeofservice.pdf) 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) 01.11 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 01.11.01 Start Date/Time 01.11.02 End Date/Time

13 LOINC Code NMMDS Component Data Type NMMDS Code 52826-5 NMMDS panel Facility Answer List 52827-3 Facility unique identifier panel Panel 01 45399-3 Federal provider number Facility Enumerated (See 01.01 Link) 52828-1 Federal provider name Facility Text 01.12 52830-7 State, district or territory federal Enumerated (See 01.07 abbreviation Facility Link) 52831-5 ZIP code Facility Enumerated (See 01.08 Link) 52829-9 Place of service Enumerated (See 01.10 Link) 52832-3 Survey reporting period start date Date 01.11.01 Facility 52833-1 Survey reporting period end date Facility Date 01.11.02 02 Type of Nursing Delivery Unit/Service The unique name, identifier, and type of nursing unit or service for each component of the facility. 02.01 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. 02.02 Unique Unit Name The name assigned to a unit by the facility, which only has meaning within the facility. 02.04 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 http://www.nursingquality.org/documents/public/appendix%20d.pdf). 02.04.01 Adult Critical Care Unit 02.04.01.01 Adult Burn Critical Care Unit 02.04.01.02 Adult Cardiothoracic Critical Care Unit 02.04.01.03 Adult Coronary Critical Care Unit 02.04.01.04 Adult Medical Critical Care Unit 02.04.01.05 Adult Neurology Critical Care Unit

14 02.04.01.06 Adult Pulmonary Critical Care Unit 02.04.01.07 Adult Surgical Critical Care Unit 02.04.01.08 Adult Trauma Critical Care Unit 02.04.02 Adult Step-down Unit 02.04.02.01 Adult Med-Surg Step-down Unit 02.04.02.02 Adult Medical Step-down Unit 02.04.02.03 Adult Surgical Step-down Unit 02.04.03 Adult Medical Unit 02.04.03.01 Adult Bone Marrow Transplant Medical Unit 02.04.03.02 Adult Cardiac Medical Unit 02.04.03.03 Adult Gastrointestinal Medical Unit 02.04.03.04 Adult Infectious Disease Medical Unit 02.04.03.05 Adult Neurology Medical Unit 02.04.03.06 Adult Oncology Medical Unit 02.04.03.07 Adult Renal Medical Unit 02.04.03.08 Adult Respiratory Medical Unit 02.04.04 Adult Surgical Unit 02.04.04.01 Adult Bariatric Surgical Unit 02.04.04.02 Adult Cardiothoracic Surgical Unit 02.04.04.03 Adult Gynecology Surgical Unit 02.04.04.04 Adult Neurosurgery Surgical Unit 02.04.04.05 Adult Orthopedic Surgical Unit 02.04.04.06 Adult Plastics Surgical Unit 02.04.04.07 Adult Transplant Surgical Unit 02.04.04.08 Adult Trauma Surgical Unit 02.04.05 Adult Med-Surg Combination Unit 02.04.05.01 Adult Cardiac Med-Surg Combination Unit 02.04.05.02 Adult Neuro/Neurosurgery Med-Surg Combination Unit

15 02.04.05.03 Adult Oncology Med-Surg Combination Unit 02.04.06 Adult Obstetrics Unit 02.04.06.01 Adult Obstetrics Ante-Partum Unit 02.04.06.02 Adult Obstetrics Labor & Delivery Unit 02.04.06.03 Adult Obstetrics Mother/Baby Combined Unit 02.04.06.04 Adult Obstetrics Post-Partum Unit 02.04.07 Other Adult Skilled Nursing Unit 02.04.08 Other Adult Mixed Acuity Unit 02.04.09 Neonatal Level I Neonate-Continuing Care Unit 02.04.10 Neonatal Level II Neonate-Intermediate Care Unit 02.04.11 Neonatal Level III/IV Neonatal Critical Care Unit 02.04.12 Neonatal Well Baby Nursery Unit 02.04.13 Neonatal Mixed Acuity Unit 02.04.14 Adult Rehabilitation Unit 02.04.14.01 Adult Brain Injury/Spinal Cord Injury Rehabilitation Unit 02.04.14.02 Adult Cardiopulmonary Rehabilitation Unit 02.04.14.03 Adult Neurology/Stroke Rehabilitation Unit 02.04.14.04 Adult Orthopedic/Amputee Rehabilitation Unit 02.04.15 Pediatric Rehabilitation Unit 02.04.16 Mixed Acuity Rehabilitation Unit 02.04.17 Pediatric Critical Care Unit 02.04.17.01 Pediatric Burn Critical Care Unit 02.04.17.02 Pediatric Cardiothoracic Critical Care Unit 02.04.17.03 Pediatric Coronary Critical Care Unit 02.04.17.04 Pediatric Medical Critical Care Unit 02.04.17.05 Pediatric Neurology Critical Care Unit 02.04.17.06 Pediatric Pulmonary Critical Care Unit 02.04.17.07 Pediatric Surgical Critical Care Unit

16 02.04.17.08 Pediatric Trauma Critical Care Unit 02.04.18 Pediatric Step Down Unit 02.04.18.01 Pediatric Med-Surg Step-down Unit 02.04.18.02 Pediatric Medical Step-down Unit 02.04.18.03 Pediatric Surgical Step-down Unit 02.04.19 Pediatric Medical Unit 02.04.19.01 Pediatric Bone Marrow Transplant Medical Unit 02.04.19.02 Pediatric Cardiac Medical Unit 02.04.19.03 Pediatric Gastrointestinal Medical Unit 02.04.19.04 Pediatric Infectious Disease Medical Unit 02.04.19.05 Pediatric Neurology Medical Unit 02.04.19.06 Pediatric Oncology Medical Unit 02.04.19.07 Pediatric Renal Medical Unit 02.04.19.08 Pediatric Respiratory Medical Unit 02.04.20 Pediatric Surgical Unit 02.04.20.01 Pediatric Bariatric Surgical Unit 02.04.20.02 Pediatric Cardiothoracic Surgical Unit 02.04.20.03 Pediatric Gynecology Surgical Unit 02.04.20.04 Pediatric Neurosurgery Surgical Unit 02.04.20.05 Pediatric Orthopedic Surgical Unit 02.04.20.06 Pediatric Plastics Surgical Unit 02.04.20.07 Pediatric Transplant Surgical Unit 02.04.20.08 Pediatric Trauma Surgical Unit 02.04.21 Pediatric Med-Surg Combination Unit 02.04.21.01 Pediatric Cardiac Med-Surg Combination Unit 02.04.21.02 Pediatric Neurology/Neurosurgery Combination Unit 02.04.21.03 Pediatric Oncology Med-Surg Combination Unit 02.04.22 Pediatric Mixed Acuity Unit

17 02.04.23 Adult Psychiatric Inpatient Unit 02.04.23.01 Adult General Psychiatric Inpatient Unit 02.04.23.02 Adult Intensive Psychiatric Inpatient Unit 02.04.23.03 Adult Mixed Acuity Psychiatric Inpatient Unit 02.04.24 Adolescent Psychiatric Inpatient Unit 02.04.24.01 Adolescent General Psychiatric Inpatient Unit 02.04.24.02 Adolescent Intensive Psychiatric Inpatient Unit 02.04.24.03 Adolescent Mixed Acuity Psychiatric Inpatient Unit 02.04.25 Child Psychiatric Inpatient Unit 02.04.25.01 Child General Psychiatric Inpatient Unit 02.04.25.02 Child Intensive Psychiatric Inpatient Unit 02.04.25.03 Child Mixed Acuity Psychiatric Inpatient Unit 02.04.26 Child-Adolescent Psychiatric Inpatient Unit 02.04.26.01 Child-Adolescent General Psychiatric Inpatient Unit 02.04.26.02 Child-Adolescent Intensive Psychiatric Inpatient Unit 02.04.26.03 Child-Adolescent Mixed Acuity Psychiatric Inpatient Unit 02.04.27 Geripsych Inpatient Unit 02.04.27.01 Geripsych General Psychiatric Inpatient Unit 02.04.27.02 Geripsych Intensive Psychiatric Inpatient Unit 02.04.27.03 Geripsych Mixed Acuity Psychiatric Inpatient Unit 02.04.28 Behavioral Health Inpatient Unit 02.04.28.01 Behavioral Health General Psychiatric Inpatient Unit 02.04.28.02 Behavioral Health Intensive Psychiatric Inpatient Unit 02.04.28.03 Behavioral Health Mixed Acuity Psychiatric Inpatient Unit 02.04.29 Specialty Psychiatric Inpatient Unit 02.04.29.01 Specialty Psychiatric General Inpatient Unit 02.04.29.02 Specialty Psychiatric Intensive Inpatient Unit 02.04.29.03 Specialty Psychiatric Mixed Acuity Inpatient Unit

18 02.04.30 Multiple Psychiatric Unit Types Inpatient Unit 02.04.30.01 Multiple Psychiatric Unit Types General Inpatient Unit 02.04.30.02 Multiple Psychiatric Unit Types Intensive Inpatient Unit 02.04.30.03 Multiple Psychiatric Unit Types Mixed Acuity Inpatient Unit 02.04.31 Other Psychiatric Inpatient or Outpatient Units 02.04.31.01 Psychiatric Day Hospital 02.04.31.02 Outpatient Psychiatric Clinics 02.04.31.03 Psychiatric Residential Unit (no 24/7 nurse) 02.04.32 Emergency Department 02.04.32.01 General Emergency Department 02.04.32.02 Obstetrics Emergency Department 02.04.32.03 Pediatric Emergency Department 02.04.32.04 Urgent Care Emergency Department 02.04.33 Peri-operative Unit 02.04.33.01 Post Anesthesia Care Unit 02.04.33.02 Pre-Op Holding 02.04.33.03 Operating Room 02.04.33.04 Same Day/Ambulatory Surgery 02.04.34 General Ambulatory Care 02.04.34.01 Cardiac Rehabilitation Clinic 02.04.34.02 Outpatient Clinics 02.04.34.03 Outpatient Rehabilitation Clinic 02.04.34.04 Radiation Therapy Clinic 02.04.34.05 Wound Care Clinic 02.04.35 Interventional Unit 02.04.35.01 Bronchoscopy Unit 02.04.35.02 Catheterization Lab Unit 02.04.35.03 Dialysis Unit

19 02.04.35.04 Gastrointestinal Clinic 02.04.35.05 Infusion Unit 02.04.35.06 Pain Management Unit 02.04.35.07 Radiology Unit 02.04.35.08 Short Stay Unit 02.04.36 Other Clinic ou Unit 02.04.36.01 Home Health Clinic 02.04.36.02 Hospice/Palliative Care Clinic 02.04.36.03 Long Term Care Unit 02.04.36.04 Patient Preparation/Education Clinic 02.04.36.05 Work Group Clinic 02.04.36.06 Public Health Clinic 02.04.36.07 School Health Clinic 02.04.36.08 Aerospace Clinic 02.04.36.09 Continence Care Clinic 02.04.36.10 Flight Clinic 02.04.36.11 Genetics/Genetics Counseling Clinic 02.04.36.12 Health Promotion Clinic 02.04.36.13 Infection Control Clinic 02.04.36.14 Nutrition Support Clinic 02.04.36.15 Occupational Health Clinic 02.04.36.16 Ophthalmic Clinic 02.04.36.17 Ostomy Care Clinic 02.04.36.18 Reproductive Endocrinology/Infertility Clinic 02.04.36.19 Women's Health Care, Ambulatory Clinic

20 LOINC Coding LOINC Code NMMDS Component Data Type NMMDS Code 52826-5 NMMDS panel Facility Answer ID NMMDS Code 52834-9 NMMDS nursing delivery unit or service 02 panel Facility 52836-4 Nursing unit cost center Text 02.01 52835-6 Nursing unit name Text 02.02 52837-2 Type of nursing unit or service [NDNQI] LL599-2 02.04 LOINC Answer List 52837-2 - 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 LL599-2. Data can be captured at the higher level which are NMMDS codes that are 02.04.xx or at more granular level, which are codes that are 02.04.xx.xx. Sequence # NMMDS Component Answer ID NMMDS Code 1 Adult Critical Care Unit LA10142-0 02.04.01 2 Adult Burn Critical Care Unit LA10143-8 02.04.01.01 3 Adult Cardiothoracic Critical Care Unit LA10144-6 02.04.01.02 4 Adult Coronary Critical Care Unit LA10145-3 02.04.01.03 5 Adult Medical Critical Care Unit LA10146-1 02.04.01.04 6 Adult Neurology Critical Care Unit LA10147-9 02.04.01.05 7 Adult Pulmonary Critical Care Unit LA10148-7 02.04.01.06 8 Adult Surgical Critical Care Unit LA10149-5 02.04.01.07 9 Adult Trauma Critical Care Unit LA10150-3 02.04.01.08 10 Adult Step-down Unit LA10151-1 02.04.02 11 Adult Med-Surg Step-down Unit LA10152-9 02.04.02.01 12 Adult Medical Step-down Unit LA10153-7 02.04.02.02 13 Adult Surgical Step-down Unit LA10154-5 02.04.02.03 14 Adult Medical Unit LA10155-2 02.04.03 15 Adult Bone Marrow Transplant Medical LA10156-0 02.04.03.01 Unit 16 Adult Cardiac Medical Unit LA10157-8 02.04.03.02 17 Adult Gastrointestinal Medical Unit LA10158-6 02.04.03.03 18 Adult Infectious Disease Medical Unit LA10159-4 02.04.03.04 19 Adult Neurology Medical Unit LA10160-2 02.04.03.05 20 Adult Oncology Medical Unit LA10161-0 02.04.03.06 21 Adult Renal Medical Unit LA10162-8 02.04.03.07 22 Adult Respiratory Medical Unit LA10163-6 02.04.03.08 23 Adult Surgical Unit LA10164-4 02.04.04 24 Adult Bariatric Surgical Unit LA10165-1 02.04.04.01 25 Adult Cardiothoracic Surgical Unit LA10166-9 02.04.04.02

21 26 Adult Gynecology Surgical Unit LA10167-7 02.04.04.03 27 Adult Neurosurgery Surgical Unit LA10168-5 02.04.04.04 28 Adult Orthopedic Surgical Unit LA10169-3 02.04.04.05 29 Adult Plastics Surgical Unit LA10170-1 02.04.04.06 30 Adult Transplant Surgical Unit LA10171-9 02.04.04.07 31 Adult Trauma Surgical Unit LA10172-7 02.04.04.08 32 Adult Med-Surg Combination Unit LA10173-5 02.04.05 33 Adult Cardiac Med-Surg Combination LA10174-3 02.04.05.01 Unit 34 Adult Neuro/Neurosurgery Med-Surg LA10175-0 02.04.05.02 Combination Unit 35 Adult Oncology Med-Surg Combination LA10176-8 02.04.05.03 Unit 36 Adult Obstetrics Unit LA10177-6 02.04.06 37 Adult Obstetrics Ante-Partum Unit LA10178-4 02.04.06.01 38 Adult Obstetrics Labor & Delivery Unit LA10179-2 02.04.06.02 39 Adult Obstetrics Mother/Baby Combined LA10180-0 02.04.06.03 Unit 40 Adult Obstetrics Post-Partum Unit LA10181-8 02.04.06.04 41 Other Adult Skilled Nursing Unit LA10182-6 02.04.07 42 Other Adult Mixed Acuity Unit LA10183-4 02.04.08 43 Neonatal Level I Neonate-Continuing Care LA10184-2 02.04.09 Unit 44 Neonatal Level II Neonate-Intermediate LA10185-9 02.04.10 Care Unit 45 Neonatal Level III/IV Neonatal Critical LA10186-7 02.04.11 Care Unit 46 Neonatal Well Baby Nursery Unit LA10187-5 02.04.12 47 Neonatal Mixed Acuity Unit LA10188-3 02.04.13 48 Adult Rehabilitation Unit LA10189-1 02.04.14 49 Adult Brain Injury/Spinal Cord Injury LA10190-9 02.04.14.01 Rehabilitation Unit 50 Adult Cardiopulmonary Rehabilitation LA10191-7 02.04.14.02 Unit 51 Adult Neurology/Stroke Rehabilitation LA10192-5 02.04.14.03 Unit 52 Adult Orthopedic/Amputee Rehabilitation LA10193-3 02.04.14.04 Unit 53 Pediatric Rehabilitation Unit LA10194-1 02.04.15 54 Mixed Acuity Rehabilitation Unit LA10195-8 02.04.16 55 Pediatric Critical Care Unit LA10196-6 02.04.17 56 Pediatric Burn Critical Care Unit LA10197-4 02.04.17.01 57 Pediatric Cardiothoracic Critical Care LA10198-2 02.04.17.02 Unit 58 Pediatric Coronary Critical Care Unit LA10199-0 02.04.17.03 59 Pediatric Medical Critical Care Unit LA10200-6 02.04.17.04

22 60 Pediatric Neurology Critical Care Unit LA10201-4 02.04.17.05 61 Pediatric Pulmonary Critical Care Unit LA10202-2 02.04.17.06 62 Pediatric Surgical Critical Care Unit LA10203-0 02.04.17.07 63 Pediatric Trauma Critical Care Unit LA10204-8 02.04.17.08 64 Pediatric Step Down Unit LA10205-5 02.04.18 65 Pediatric Med-Surg Step-down Unit LA10206-3 02.04.18.01 66 Pediatric Medical Step-down Unit LA10207-1 02.04.18.02 67 Pediatric Surgical Step-down Unit LA10208-9 02.04.18.03 68 Pediatric Medical Unit LA10209-7 02.04.19 69 Pediatric Bone Marrow Transplant LA10210-5 02.04.19.01 Medical Unit 70 Pediatric Cardiac Medical Unit LA10211-3 02.04.19.02 71 Pediatric Gastrointestinal Medical Unit LA10212-1 02.04.19.03 72 Pediatric Infectious Disease Medical LA10213-9 02.04.19.04 Unit 73 Pediatric Neurology Medical Unit LA10214-7 02.04.19.05 74 Pediatric Oncology Medical Unit LA10215-4 02.04.19.06 75 Pediatric Renal Medical Unit LA10216-2 02.04.19.07 76 Pediatric Respiratory Medical Unit LA10217-0 02.04.19.08 77 Pediatric Surgical Unit LA10218-8 02.04.20 78 Pediatric Bariatric Surgical Unit LA10219-6 02.04.20.01 79 Pediatric Cardiothoracic Surgical Unit LA10220-4 02.04.20.02 80 Pediatric Gynecology Surgical Unit LA10221-2 02.04.20.03 81 Pediatric Neurosurgery Surgical Unit LA10222-0 02.04.20.04 82 Pediatric Orthopedic Surgical Unit LA10223-8 02.04.20.05 83 Pediatric Plastics Surgical Unit LA10224-6 02.04.20.06 84 Pediatric Transplant Surgical Unit LA10225-3 02.04.20.07 85 Pediatric Trauma Surgical Unit LA10226-1 02.04.20.08 86 Pediatric Med-Surg Combination Unit LA10227-9 02.04.21 87 Pediatric Cardiac Med-Surg Combination LA10228-7 02.04.21.01 Unit 88 Pediatric Neurology/Neurosurgery LA10229-5 02.04.21.02 Combination Unit 89 Pediatric Oncology Med-Surg LA10230-3 02.04.21.03 Combination Unit 90 Pediatric Mixed Acuity Unit LA10231-1 02.04.22 91 Adult Psychiatric Inpatient Unit LA10232-9 02.04.23 92 Adult General Psychiatric Inpatient Unit LA10233-7 02.04.23.01 93 Adult Intensive Psychiatric Inpatient LA10234-5 02.04.23.02 Unit 94 Adult Mixed Acuity Psychiatric Inpatient LA10235-2 02.04.23.03 Unit 95 Adolescent Psychiatric Inpatient Unit LA10236-0 02.04.24 96 Adolescent General Psychiatric Inpatient Unit LA10237-8 02.04.24.01

23 97 Adolescent Intensive Psychiatric Inpatient LA10238-6 02.04.24.02 Unit 98 Adolescent Mixed Acuity Psychiatric LA10239-4 02.04.24.03 Inpatient Unit 99 Child Psychiatric Inpatient Unit LA10240-2 02.04.25 100 Child General Psychiatric Inpatient Unit LA10241-0 02.04.25.01 101 Child Intensive Psychiatric Inpatient LA10242-8 02.04.25.02 Unit 102 Child Mixed Acuity Psychiatric Inpatient LA10243-6 02.04.25.03 Unit 103 Child-Adolescent Psychiatric Inpatient LA10244-4 02.04.26 Unit 104 Child-Adolescent General Psychiatric LA10245-1 02.04.26.01 Inpatient Unit 105 Child-Adolescent Intensive Psychiatric LA10246-9 02.04.26.02 Inpatient Unit 106 Child-Adolescent Mixed Acuity LA10247-7 02.04.26.03 Psychiatric Inpatient Unit 107 Geripsych Inpatient Unit LA10248-5 02.04.27 108 Geripsych General Psychiatric Inpatient LA10249-3 02.04.27.01 Unit 109 Geripsych Intensive Psychiatric Inpatient LA10250-1 02.04.27.02 Unit 110 Geripsych Mixed Acuity Psychiatric LA10251-9 02.04.27.03 Inpatient Unit 111 Behavioral Health Inpatient Unit LA10252-7 02.04.28 112 Behavioral Health General Psychiatric LA10253-5 02.04.28.01 Inpatient Unit 113 Behavioral Health Intensive Psychiatric LA10254-3 02.04.28.02 Inpatient Unit 114 Behavioral Health Mixed Acuity LA10255-0 02.04.28.03 Psychiatric Inpatient Unit 115 Specialty Psychiatric Inpatient Unit LA10256-8 02.04.29 116 Specialty Psychiatric General Inpatient LA10257-6 02.04.29.01 Unit 117 Specialty Psychiatric Intensive Inpatient LA10258-4 02.04.29.02 Unit 118 Specialty Psychiatric Mixed Acuity LA10259-2 02.04.29.03 Inpatient Unit 119 Multiple Psychiatric Unit Types Inpatient LA10260-0 02.04.30 Unit 120 Multiple Psychiatric Unit Types General LA10261-8 02.04.30.01 Inpatient Unit 121 Multiple Psychiatric Unit Types Intensive Inpatient Unit LA10262-6 02.04.30.02

24 122 Multiple Psychiatric Unit Types Mixed LA10263-4 02.04.30.03 Acuity Inpatient Unit 123 Other Psychiatric Inpatient or Outpatient LA10264-2 02.04.31 Units 124 Psychiatric Day Hospital LA10265-9 02.04.31.01 125 Outpatient Psychiatric Clinics LA10266-7 02.04.31.02 126 Psychiatric Residential Unit (no 24/7 LA10267-5 02.04.31.03 nurse) 127 Emergency Department LA10268-3 02.04.32 128 General Emergency Department LA10269-1 02.04.32.01 129 Obstetrics Emergency Department LA10270-9 02.04.32.02 130 Pediatric Emergency Department LA10271-7 02.04.32.03 131 Urgent Care Emergency Department LA10272-5 02.04.32.04 132 Peri-operative Unit LA10273-3 02.04.33 133 Post Anesthesia Care Unit LA10274-1 02.04.33.01 134 Pre-Op Holding LA10275-8 02.04.33.02 135 Operating room LA7222-8 02.04.33.03 136 Same Day/Ambulatory Surgery LA10277-4 02.04.33.04 137 General Ambulatory Care LA10278-2 02.04.34 138 Cardiac Rehabilitation Clinic LA10279-0 02.04.34.01 139 Outpatient Clinics LA10280-8 02.04.34.02 140 Outpatient Rehabilitation Clinic LA10281-6 02.04.34.03 141 Radiation Therapy Clinic LA10282-4 02.04.34.04 142 Wound Care Clinic LA10283-2 02.04.34.05 143 Interventional Unit LA10284-0 02.04.35 144 Bronchoscopy Unit LA10285-7 02.04.35.01 145 Catheterization Lab Unit LA10286-5 02.04.35.02 146 Dialysis unit LA10287-3 02.04.35.03 147 Gastrointestinal Clinic LA10288-1 02.04.35.04 148 Infusion Unit LA10289-9 02.04.35.05 149 Pain Management Unit LA10290-7 02.04.35.06 150 Radiology Unit LA10291-5 02.04.35.07 151 Short Stay Unit LA10292-3 02.04.35.08 152 Other Unit or Clinic LA10293-1 02.04.36 153 Home Health Clinic LA10294-9 02.04.36.01 154 Hospice/Palliative Care Unit LA10295-6 02.04.36.02 155 Long Term Care Unit LA10296-4 02.04.36.03 156 Patient Preparation/Education Clinic LA10297-2 02.04.36.04 157 Work Group Clinic LA10298-0 02.04.36.05 158 Public Health Clinic LA10299-8 02.04.36.06 159 School Health Clinic LA10300-4 02.04.36.07 160 Aerospace Clinic LA10301-2 02.04.36.08 161 Continence Care Clinic LA10302-0 02.04.36.09 162 Flight Clinic LA10303-8 02.04.36.10 163 Genetics/Genetics Counseling Clinic LA10304-6 02.04.36.11

25 164 Health Promotion Clinic LA10305-3 02.04.36.12 165 Infection Control Clinic LA10306-1 02.04.36.13 166 Nutrition Support Clinic LA10307-9 02.04.36.14 167 Occupational Health Clinic LA10308-7 02.04.36.15 168 Ophthalmic Clinic LA10309-5 02.04.36.16 169 Ostomy Care Clinic LA10310-3 02.04.36.17 170 Reproductive Endocrinology/Infertility LA10311-1 02.04.36.18 Clinic 171 Women's Health Care, Ambulatory Clinic LA10312-9 02.04.36.19 03 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. 03.02 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 http://www.seer.cancer.gov/stdpopulations/stdpop.19ages.html) 03.02.01 Fetal 03.02.02 0 28 days (neonatal) 03.02.03 29 days - 1 year 03.02.04 01-04 years 03.02.05 05-09 years 03.02.06 10-14 years 03.02.07 15-19 years 03.02.08 20-24 years 03.02.09 25-29 years 03.02.10 30-34 years 03.02.11 35-39 years 03.02.12 40-44 years 03.02.13 45-49 years

26 03.02.14 50-54 years 03.02.15 55-59 years 03.02.16 60-64 years 03.02.17 65-69 years 03.02.18 70-74 years 03.02.19 75-79 years 03.02.20 80-84 years 03.02.21 85+ years 03.03 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. 03.03.01 Neighborhood 03.03.02 City or Town 03.03.03 District catchment area 03.03.04 County catchment area 03.03.05 Parish catchment area 03.03.06 State catchment area 03.03.07 Region catchment area 03.03.08 Nation catchment area 03.03.09 World catchment area 03.03.10 Aerospace catchment area 03.03.11 Nautical catchment area 03.04 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 03 52839-0 Population distribution panel (chronological age) % for each age group 03.02

27 52861-2 Catchment area panel population % for each 03.03 catchment group 52839-8 Total patient population # # 03.04 LOINC Answer List 52839-0 Population distribution panel (chronological age) [NMMDS] use answers below Sequence # NMMDS Component Answer Type NMMDS Code 52839-0 Population distribution panel (chronological age) 03.02 52840-6 Total population of fetal age population % 03.02.01 52841-4 Total population of age birth to 28 days % 03.02.02 population 52842-2 Total population of age 29 days to 1 year % 03.02.03 population 52843-0 Total population of age 1-4 years population % 03.02.04 52844-8 Total population of age 5-9 years population % 03.02.05 52845-5 Total population of age 10-14 years population % 03.02.06 52846-3 Total population of age 15-19 years population % 03.02.07 52847-1 Total population of age 20-24 years population % 03.02.08 52848-9 Total population of age 25-29 years population % 03.02.09 52849-7 Total population of age 30-34 years population % 03.02.10 52850-5 Total population of age 35-39 years population % 03.02.12 52851-3 Total population of age 40-44 years population % 03.02.13 52852-1 Total population of age 45-49 years population % 03.02.14 52853-9 Total population of age 50-54 years population % 03.02.15 52854-7 Total population of age 55-59 years population % 03.02.16 52855-4 Total population of age 60-64 years population % 03.02.17 52856-2 Total population of age 65-69 years population % 03.02.18 52857-0 Total population of age 70-74 years population % 03.02.19 52859-6 Total population of age 80-84 years population % 03.02.20 52860-4 Total population of age GE 85 years population % 03.02.21 52861-2 Catchment area panel population [NMMDS] use answers below Sequence# NMMDS Component Answer Type NMMDS Code 52861-2 Catchment area panel population 03.03 52862-0 Neighborhood catchment area population % 03.03.01 [Estimated] 52863-8 City or town catchment area population % 03.03.02 [Estimated] 52864-6 District catchment area population [Estimated] % 03.03.03 52865-3 County catchment area population [Estimated] % 03.03.04 52866-1 Parish catchment area population [Estimated] % 03.03.05

28 52867-9 State catchment area population [Estimated] % 03.03.06 52868-7 Region catchment area population [Estimated] % 03.03.07 52869-5 Nation catchment area population [Estimated] % 03.03.08 52870-3 World catchment area population [Estimated] % 03.03.09 52871-1 Aerospace catchment area population % 03.03.10 [Estimated] 52872-9 Nautical catchment area population [Estimated] % 03.03.11 04 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) 4,5. 04.01 Type of Nursing Provider - A designation for nursing personnel based on educational preparation, licensure, or certification. 04.01.01 Certified Advanced Practice Nurse (APN) 04.01.02 Registered Nurse, not APN 04.01.03 Licensed Practical/ Vocational Nurse (LPN/ LVN) 04.01.04 Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide 04.01.05 Total nursing personnel that includes APN, registered nurse, LPN/ LVN, and UAP 04.02 Type of Client 04.02.01 Individual Client- An individual who can be uniquely identified 6,7 and is the recipient of health care or health related services 5. 04.02.01 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 04.02.02 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.) 11. 04.03 Type of Encounter 04.03.01 Patient Days - the patient census for a unit or service in a 24 hour period 12. 04.03.02 Method 1: Patient Days: Midnight Census The daily number should be summed for every day in the month 12(p1). 04.03.03 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). 04.03.04 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). 04.03.01 Method 4: Patient Days: Actual Hours - Sum actual hours for all patients, whether in-patient or short stay, and divide by 24 12(p2). 04.03.01 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). 04.03.01 Visits - A provider-patient interaction either in person or via telehealth or other face-face technologies.

30 04.03.01 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 13. 04.03.01 Contacts - An interaction with a client that is not otherwise counted in other categories. Examples might be phone calls, mailing, emailing or other methods of connecting with a patient. 04.03.01 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. 04.03.01 Classes - Two or more patients with a common learning need for which knowledge, skills or attitudes are addressed. 04.04 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) 15. 04.05 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. 04.06 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 57126-5 Volume of nursing delivery unit or 04 service panel 57120-8 Type of nursing provider [NMMDS] LL767-5 04.01 57121-6 Type of client [NMMDS] LL768-3 04.02 57122-4 Type of encounter [NMMDS] LL769-1 04.03 57123-2 Hours designated [Estimate] h 04.04 57124-0 Care capacity # [Estimate] {#} 04.05 57125-7 Care provided # {#} 04.06 LOINC Answer List 57120-8 Type of nursing provider [NMMDS] - Normative answer list (LL767-5) Sequence # NMMDS Component Answer ID NMMDS Code 1 APN LA12063-6 04.01.01 2 RN LA6367-2 04.01.02 3 LPN/ LVN LA12071-9 04.01.03 4 UAP LA12085-9 04.01.04 5 Total nursing personnel LA12083-4 04.01.05 57121-6 Type of client [NMMDS] - Normative answer list (LL768-3) Sequence # NMMDS Component Answer ID NMMDS Code 1 Individual LA12070-1 04.02.01 2 Family LA12068-5 04.02.02 3 Population LA12078-4 04.02.03 57122-4 Type of encounter [NMMDS] - Normative answer list (LL769-1) Sequence # NMMDS Component Answer ID NMMDS Code 1 Patient days method 1 LA12073-5 04.03.01 2 Patient days method 2 LA12074-3 04.03.02 3 Patient days method 3 LA12075-0 04.03.03 4 Patient days method 4 LA12076-8 04.03.04 5 Patient days method 5 LA12077-6 04.03.05 6 Visits LA12086-7 04.03.06 7 Consults LA12066-9 04.03.07 8 Contacts LA12067-7 04.03.08 9 Programs LA12080-0 04.03.09 10 Classes LA12065-1 04.03.10 RECOMMENDED CODING

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 04 01 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 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 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 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 16,17. 05.02 Functional - Nursing care organized and delineated by the specific tasks and technical aspects provided to a group of patients/clients 18-21. 05.03 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 17-21. 05.04 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 17,19,21. 05.05 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 17-19,21. 05.06 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 17,22,23. 05.07 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

healthcare clinical services supplied by groups of providers with the aims of cost effectiveness, quality, and accessibility 24(p29). 05.09 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 http://www.nursingworld.org/documentvault/aprns/consensusmodelforaprn Regulation.aspx) 25. LOINC Code NMMDS Component Answer ID NMMDS Code 57127-3 Method of care delivery LL770-9 05 36 LOINC Answer List 57127-3 Method of care delivery [NMMDS] - Normative answer list for LL770-9. Sequence # NMMDS Component Answer ID NMMDS Code 1 Functional LA12069-3 05.02 2 Team LA12082-6 05.03 3 Total patient care LA12084-2 05.04 4 Primary nursing LA12079-2 05.05 5 Case management LA12064-4 05.06 6 Managed care LA12072-7 05.07 7 Advanced practice nursing LA12062-8 05.09 06 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, email, etc.) or types of procedures/processes used to connect with clients (e.g., synchronous or asynchronous communications).

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. 06.07 Average time (in minutes) to access the client per encounter 06.08 Average distance required to travel for an encounter 06.09 Method used to connect with client for an encounter (select all that apply) 06.09.01 walking. 06.09.02 motorized vehicle. 06.09.03 nonmotorized vehicle (i.e. bicycle). 06.09.04 asynchronous electronic communication e.g., email or blogging. 06.09.05 synchronous communication e.g., telephone, telehealth video visit. 06.09.06 monitoring the client from the nurses station e.g., remote camera monitoring. 06.09.07 monitoring the client observing in client(s) room e.g., sitting in client room. 06.10 Average time (in minutes) required to gather essential resources for an encounter

38 06.11 Average distance (in meters) required to gather essential resources for an LOINC Coding encounter. LOINC Code NMMDS Component Data Type NMMDS Code 77548-6 Client accessibility panel [NMMDS] 06 77549-4 Time to access a patient [NMMDS] min 77550-2 Time to access all patients in a Report Period min [NMMDS] 77551-0 Total number of patient encounters in a {#} reporting period [NMMDS] 77552-8 Average time to access a patient in a Report min 06.07 Period [NMMDS] 77553-6 Distance to access a patient [NMMDS] m 77554-4 Distance to access all patients in a Report m Period [NMMDS] 77555-1 Average distance to access a patient in a m Report Period [NMMDS] 77556-9 Method used to connect with a patient 06.09 [NMMDS] 77557-7 Time required to gather essential resources min 06.10 for a patient encounter [NMMDS] 77558-5 Time required to gather essential resources min for all patient encounters in a Report Period [NMMDS] 77559-3 Average time required to gather essential min resources for a patient encounter in a Report Period [NMMDS] 77560-1 Distance required to gather essential m resources for a patient encounter [NMMDS] 77561-9 Distance required to gather essential m resources for all patient encounters in a Report Period [NMMDS] 77562-7 Average distance required to gather essential resources for a patient encounter in a Report Period [NMMDS] m 06.11 LOINC Answer List 77556-9 Method used to connect with a patient [NMMDS] - Normative answer list for LL3621-1. Sequence # NMMDS Component Answer ID NMMDS Code 1 Walking LA11834-1 06.09.01

39 2 Motorized vehicle LA24006-1 06.09.02 3 Nonmotorized vehicle (e.g. bicycle) LA24007-9 06.09.03 4 Asynchronous electronic communication LA24008-7 06.09.04 (e.g., email, blogging) 5 Synchronous communication (e.g., telephone, LA24009-5 06.09.05 telehealth video visit) 6 Monitoring from the nurses station (e.g., LA24010-3 06.09.06 remote camera monitoring) 7 Monitoring in the client(s) room (e.g., sitting in client room) LA24011-1 06.09.07 10 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. 10.03 Accreditation 10.03.01 The Joint Commission Accreditation 28 10.03.02 Accreditation Association for Ambulatory Health Care (AAAHC) 29 10. 03.03 Accreditation Commission for Health Care, Inc. (ACHC) 30 10. 03.04 American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) 31 10. 03.05 American Osteopathic Association (AOA) Accreditation Program 32 10. 03.06 Healthcare Facilities Accreditation Program (HFAP) 33 10. 03.07 Community Health Accreditation Program (CHAP) 34 10. 03. 08 DNV Healthcare (DNVHC) Accreditation Program 35

40 10.04 Certification 10.04.01 The Joint Commission Certification 28 10.04.02 DNV (Det Norske Veritas) Healthcare Accreditation Program 35 10.04.03 Medicare Certification 10.05 Licensure LOINC Coding 10.05.01 State Licensure LOINC Code NMMDS Component Answer ID NMMDS Code 75533-0 NMMDS accreditation, certification, and 10 licensure panel 75533-0 Applicable accrediting agency for unit LL3062-8 10.03 75534-8 Accreditation received LL3062-8 75536-3 Applicable certification agency for unit 10.04 75535-5 Certification received 75537-1 Applicable licensing agency for unit LL3064-4 10.05 75538-9 Licensing received LL3064-4 LOINC Answer List 75533-0 Applicable accrediting agency for unit [NMMDS] - Normative answer list for LL3062-8 75534-8 Accreditation received [NMMDS] - Normative answer list for LL3062-8 Sequence # NMMDS Component Answer ID NMMDS Code 1 The Joint Commission Accreditation LA21572-5 10.03.01 2 Accreditation Association for Ambulatory LA21573-3 10.03.02 Health Care 3 Accreditation Commission for Health Care, Inc. LA21574-1 10.03.03 4 American Association for Accreditation of LA21575-8 10.03.04 Ambulatory Surgery Facilities (AAAASF) 5 American Osteopathic Association (AOA) LA21576-6 10.03.05 Accreditation Program 6 Healthcare Facilities Accreditation Program LA21577-4 10.03.06 (HFAP) 7 Community Health Accreditation Program LA21578-2 10.03.07 (CHAP) 8 DNV Healthcare (DNVHC) Accreditation Program 10.03.08

41 75536-3 Applicable certification agency for unit [NMMDS] - Normative answer list for LL3062-8 75535-5 Certification received [NMMDS] - Normative answer list for LL3062-8: Sequence # NMMDS Component Answer ID NMMDS Code 1 The Joint Commission Certification LA21580-8 10.04.01 2 DNV (Det Norske Veritas) Healthcare LA21581-6 10.04.02 Certification 2 Medicare Certification LA21582-4 10.04.03 75537-1 Applicable licensing agency for unit [NMMDS] - Normative answer list for LL3064-4 75538-9 Licensing received [NMMDS] - Normative answer list for LL3064-4 Sequence # NMMDS Component Answer ID NMMDS Code 1 State Licensure LA21584-0 10.05.01 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. 13.07 Nursing Staff Job Positions - The nursing staff position on a unit or service during the reporting period 13.07.01 Direct Care Staff: The direct care staff positions on a unit or service during the reporting period (dd/mm/yy) 13.07.01.01 Advanced Practice Nurses 13.07.01.02 Registered Nurses reporting to department of nursing 13.07.01.03 Licensed Practical Nurses/Licensed Vocational Nurses reporting to department of Nursing 13.07.01.04 Nurse Aids or Equivalent extenders 13.07.01.05 Nursing Students 13.07.01.06 Agency/Travelers Staff 13.07.01.07 Independent Contractors/ Sub-contractors

42 13.07.02 Management, Administrative, Support Staff: The management, administrative, or support staff on a unit or service during the reporting period 13.07.02.01 Case Manager 13.07.02.02 Nurse Manager 13.07.02.03 Staff Development/ Educators 13.07.02.04 Researchers 13.07.02.05 Nursing Quality Improvement (QI) Staff 13.07.02.06 Support Staff (e.g. unit clerks, environmental aids, techs) 13.04 Nursing Staff Quantity - The number of staff, number of full time equivalents (FTE) hours, and average daily productive staff by position. 13.04.01 Number of Actual Staff - The number of total staff actually working by position during the reporting period (dd/mm/yy). 13.04.02 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. 13.04.03 Number of Budgeted Staff - The number of total staff budgeted by position during the reporting period (dd/mm/yy). 13.04.04 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. 13.04.05 Productive staff - All staff available for care/service provision, excluding e.g.: vacation, disability, or any other type of paid time off. 13.04.06 Number of New Nurses by Job position - the number of new nursing staff by job position hired during the reporting period

43 13.04.07 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 13.04.08 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 13.04.09 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 13.04.10 Number of Nursing Staff at Beginning of the reporting by Position who remained (preexisting staff) 13.04.11 Number of Nursing Staff at Beginning of the reporting period by Position who left (preexisting staff) 13.04.12 Number of Nursing Staff by Position who left. It includes both voluntary and involuntary turnover for newly hired and preexisting staff by job position. (13.04.08 + 13.04.11) 13.04.13 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. 13.04.14 Number of Nursing Staff Positions that are unfilled 13.05 Nursing Staff Turnover - Turnover is the percent of nurses by position who are leaving a unit or service either voluntarily or involuntarily. 13.05.01 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 13.05.01.01 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. 13.05.01.02 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. 13.05.02 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. 13.05.03 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 (13.04.12) Average Number of Nurses by Position in a Unit or Service (13.04.13) 100 13.05.04 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 (13.04.14) Average Number of Nurses by Position in a Unit or Service (13.04.13) 100 13.05.05 Number of Budgeted Positions Filled 13.06 Nursing Staff Retention 13.06.01 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 Number of New Nurses by Position (13.04.06) Average Number of Nurses by Position in a Unit or Servive (13.04.13) 100 13.06.02 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 (13.04.10) Number of Nurses by Position at Beginning (13.04.09) 100 13.06.03 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 (13.04.11) Number of Nurses by Position at Beginning (13.04.09) 100 13.06.04 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 (13.04.07) Number of New Nurses by Position (13.04.06) 100 13.06.05 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 (13.04.08) Number of New Nurses by Position (13.04.06) 100

46 LOINC Coding LOINC Code NMMDS Component Data Type NMMDS Code 77255-8 Nursing staff job positions, quantity, turnover, 13 and retention panel [NMMDS] 77284-8 Nursing staff job positions panel [NMMDS] 13.07 77286-3 Direct care staff [NMMDS] 13.07.01 77287-1 Management, administrative, AndOr support 13.07.02 staff [NMMDS] 77256-6 Nursing staff quantity panel [NMMDS] 13.04 77257-4 Number of actual nursing staff by job position {#} 13.04.01 in a reporting period [NMMDS] 77258-2 Full time equivalent hours of actual nursing h 13.04.02 staff [NMMDS] 77259-0 Number of budgeted nursing staff by job {#} 13.04.03 position in a reporting period [NMMDS] 77260-8 Full time equivalent hours of budgeted h 13.04.04 nursing staff [NMMDS] 77263-2 Number of productive staff in a reporting {#} 13.04.05 period [NMMDS] 77264-0 Number of new nursing staff by job position {#} 13.04.06 in a reporting period [NMMDS] 77265-7 Number of new nursing staff by job position {#} 13.04.07 who remained in a reporting period [NMMDS] 77266-5 Number of new nursing staff by job position {#} 13.04.08 who left in a reporting period [NMMDS] 77267-3 Number of nursing staff by job position at {#} 13.04.09 beginning of a reporting period [NMMDS] 77268-1 Number of nursing staff by job position at {#} 13.04.10 beginning of a reporting period who remained [NMMDS] 77269-9 Number of nursing staff by job position at {#} 13.04.11 beginning of a reporting period who left [NMMDS] 77270-7 Number of nursing staff by job position who {#} 13.04.12 left in a reporting period [NMMDS] 77271-5 Average number of nursing staff by job {#} 13.04.13 position in a reporting period [NMMDS] 77272-3 Number of unfilled nursing staff job positions {#} 13.04.14 in a reporting period [NMMDS] 77273-1 Nursing staff turnover panel [NMMDS] 13.04 77262-4 Nursing staff.voluntary turnover/nursing staff % 13.05.01 [NMMDS] 77261-6 Nursing staff.voluntary turnover.transfer/ Nursing staff [NMMDS] % 13.05.01.01

47 77274-9 Nursing staff.voluntary turnover.terminate/ % 13.05.01.02 Nursing staff [NMMDS] 77275-6 Nursing staff.involuntary turnover/nursing % 13.05.02 staff [NMMDS] 77276-4 Turnover rate [NMMDS] % 13.05.03 77277-2 Vacancy rate [NMMDS] % 13.05.04 77278-0 Number of budgeted nursing staff job {#} 13.05.05 positions filled in a reporting period [NMMDS] 77279-8 Nursing staff retention panel [NMMDS] 13.06 77280-6 Accession rate [NMMDS] % 13.06.01 77281-4 Stability rate [NMMDS] % 13.06.02 77282-2 Instability rate [NMMDS] % 13.06.03 77283-0 Survival rate [NMMDS] % 13.06.04 77285-5 Wastage rate [NMMDS] % 13.06.05 LOINC Answer List 77286-3 Direct care staff [NMMDS] - Normative list for LL3589-0. Sequence # NMMDS Component Answer ID NMMDS Code 1 Advanced Practice Nurses LA23763-8 13.07.01.01 2 Registered Nurses reporting to department of LA23764-6 13.07.01.02 nursing 3 Licensed Practical Nurses/Licensed Vocational LA23765-3 13.07.01.03 Nurses reporting to department of nursing 4 Nurse Aids or Equivalent extenders LA23766-1 13.07.01.04 5 Nursing Students LA23767-9 13.07.01.05 6 Agency/Travelers Staff LA23768-7 13.07.01.06 7 Independent Contractors/ Sub-contractors LA23769-5 13.07.01.07 77287-1 Management, administrative, AndOr support staff [NMMDS] Normative answer list for LL390-8 Sequence # NMMDS Component Answer ID NMMDS Code 1 Case Manager LA23770-3 13.07.02.01 2 Nurse Manager LA23771-1 13.07.02.02 3 Staff Development/ Educators LA23772-9 13.07.02.03 4 Researchers LA23773-7 13.07.02.04 5 Nursing Quality Improvement (QI) Staff LA23774-5 13.07.02.05 6 Support Staff (e.g. unit clerks, environmental aids, techs) LA23775-2 13.07.02.06

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 14.11.01 Generally speaking, I am very satisfied with this job. 14.11.02 I rarely think of quitting this job. 14.11.03 I am generally satisfied with the kind of work I do in this job. 14.11.04 Most nursing staff on this job are very satisfied with the job. 14.11.05 Nursing staff on this job rarely think of quitting. 14.21.01 Generally speaking, I am very satisfied with nursing management. 14.21.02 Generally speaking, I am very satisfied with nursing administration. 14.21.03 Generally speaking, I am very satisfied with interactions with physicians.

49 14.21.04 Generally speaking, I am very satisfied with interactions with nonphysician health care team members. 14.21.05 Generally speaking, I am very satisfied with my own level of autonomy. 14.03 Total number staff taking survey LOINC Coding LOINC Code NMMDS Component Answer ID NMMDS code 74182-7 NMMDS job satisfaction panel Panel 74183-5 Nursing job class [NMMDS] Panel 74181-9 Generally speaking, I am very satisfied with LL2712-9 14.11.01 this job 74180-1 I rarely think of quitting this job LL2712-9 14.11.02 74179-3 I am generally satisfied with the kind of work I LL2712-9 14.11.03 do in this job 74178-5 Most nursing staff on this job are very satisfied LL2712-9 14.11.04 with the job 74177-7 Nursing staff on this job rarely think of quitting LL2712-9 14.11.05 74176-9 Generally speaking, I am very satisfied with LL2712-9 14.22.01 nursing management 74175-1 Generally speaking, I am very satisfied with LL2712-9 14.21.02 nursing administration 74174-4 Generally speaking, I am very satisfied with LL2712-9 14.21.03 interactions with physicians 74173-6 Generally speaking, I am very satisfied with LL2712-9 14.21.04 interactions with non-physician health care team members 74172-8 Generally speaking, I am very satisfied with my LL2712-9 14.21.05 own level of autonomy 74171-0 Total number of staff completing the job satisfaction survey LL2712-9 14.03 LOINC Answer List 74182-7 NMMDS job satisfaction panel - Normative answer list for LL2712-9 Sequence # NMMDS Component Answer ID NMMDS Code 1 Strongly disagree LA15236-5 1 2 Disagree LA15773-7 2 3 Neutral LA14786-0 3 4 Agree LA15774-5 4 5 Strongly agree LA15237-3 5

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 12 40. 19.01 Employment position 41,42 - Percent of staff on a nursing unit or service line with primary job title with assigned responsibilities. 19.01.01 Advanced Practice Registered Nurse (APRN) - A registered nurse (RN) who has a graduate degree and advanced knowledge including nurses with masters or doctoral degrees 19.01.02 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. 19.01.03 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. 19.01.04 Nurse Researcher (NR) - An RN who conducts research in the field of nursing. 19.01.05 Nurse Executive (NE) - An RN involved with management and administration concerns.

51 19.01.06 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. 19.01.07 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 19.01.08 Staff Nurse (SN) - A nurse in direct patient care who is responsible for the treatment and well-being of patients 19.02 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 19.08 for license type). 19.02.01 Female 19.02.02 Male 19.02.03 Unknown 19.03 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 19.08 for license type) 19.03.01 American Indian/Alaska Native 19.03.02 Asian 19.03.03 Black/African American 19.03.04 Native Hawaiian/Other Pacific Islander 19.03.05 White/Caucasian 19.03.06 Hispanic/Latino 19.04 Age of Staff - Age by five-year increments of staff member at the start of the reporting period (See NMMDS 01.11 for reporting period) Percent of licenses staff on a nursing unit or service line by age (see 19.08 for license type) 19.04.01 15-19 years old

52 19.04.02 20-24 years old 19.04.03 25-29 years old 19.04.04 30-34 years old 19.04.05 35-39 years old 19.04.06 40-44 years old 19.04.07 45-49 years old 19.04.08 50-54 years old 19.04.09 55-59 years old 19.04.10 60-64 years old 19.04.11 65-69 years old 19.04.12 70-74 years old 19.04.13 75+ years old 19.05 Entry Level Nursing Degree - The degree a nurse first completes to enter into nursing practice. 19.05.01 Licensed Practical /Licensed Vocational degree- Nursing 19.05.02 Associate degree- Nursing 19.05.03 Diploma- Nursing 19.05.04 Baccalaureate degree- Nursing 19.05.05 Master's degree- Nursing 19.05.06 Doctoral degree- Nursing Practice (DNP) 19.05.07 Doctoral degree- Nursing (PhD) 19.05.08 Doctoral degree- Nursing, Other 19.06 Highest Level of Education in a Nursing Degree - The highest level of education in a nursing degree. 19.06.01 Licensed Practical Licensed Vocational degree- Nursing 19.06.02 Associate degree- Nursing 19.06.03 Diploma- Nursing 19.06.04 Baccalaureate degree- Nursing

53 19.06.05 Master's degree- Nursing 19.06.06 Doctoral degree- Nursing Practice (DNP) 19.06.07 Doctoral degree- Nursing (PhD) 19.06.08 Doctoral degree- Nursing, Other 19.07 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. 19.07.01 Associate degree - Non-Nursing 19.07.02 Baccalaureate degree - Non-Nursing 19.07.03 Master's degree- Non-Nursing 19.07.04 Doctoral degree- Non-Nursing 19.08 Nursing License Type 19.08.01 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 19.08.02 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 19.08.03 Advanced Practice RN - Includes all advanced license statuses for your state 19.09 Nursing Certification 45-47 - 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. 19.09.01 Acute Care NP 19.09.02 Adult NP 19.09.03 Adult Psychiatric-Mental Health NP 19.09.04 Adult-Gerontology Acute Care NP 19.09.05 Adult-Gerontology Primary Care NP

54 19.09.06 Diabetes Management- Advanced 19.09.07 Family NP 19.09.08 Family Psychiatric- Mental Health NP 19.09.09 Gerontological NP 19.09.10 Pediatric NP 19.09.11 School NP 19.09.12 Adult- Gerontology CNS 19.09.13 Adult Health CNS 19.09.14 Adult Psychiatric- Mental Health CNS 19.09.15 Child/ Adolescent Psychiatric- Mental Health CNS 19.09.16 Gerontological CNS 19.09.17 Home Health CNS 19.09.18 Pediatric CNS 19.09.19 Public/ Community Health CNS 19.09.20 Ambulatory Care Nursing 19.09.21 Cardiac Rehabilitation Nursing 19.09.22 Cardiac- Vascular Nursing 19.09.23 Certified Vascular Nurse 19.09.24 College Health Nurse 19.09.25 Community Health Nursing 19.09.26 General Nursing Practice 19.09.27 Gerontological Nursing 19.09.28 High- Risk Perinatal Nursing 19.09.29 Home Health Nursing 19.09.30 Informatics Nursing 19.09.31 Medical- Surgical Nursing 19.09.32 Nurse Executive 19.09.33 Nurse Executive, Advanced

55 19.09.34 Nursing Case Management 19.09.35 Nursing Professional Development 19.09.36 Pain Management Nursing 19.09.37 Pediatric Nursing 19.09.38 Perinatal Nursing 19.09.39 Psychiatric- Mental Health Nursing 19.09.40 Public Health Nursing- Advanced 19.09.41 School Nursing 19.09.42 CWOCN 19.09.43 CWCN 19.09.44 CWON 19.09.45 CCCN 19.09.46 COCN 19.09.47 Certified Nurse-Midwives (CNMs) 19.10 Employment Specialty 19.10.01 Acute care/critical Care - Nurses in this specialty provide care to patients with acute conditions. They also provide care to pre- and postoperative patients 19.10.02 Anesthesia - Nurses in this specialty provide care to patients receiving anesthesia during operative procedures 19.10.03 Geriatric/Gerontology - Nurses in this specialty provide the special care needed in rehabilitating and maintaining the mental and physical health of the elderly 19.10.04 Home Health - Nurses in this specialty provide care for people in their homes, such as those recovering from illness, an accident, or childbirth 19.10.05 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 19.10.06 Maternal-Child Health - Nurses in this specialty provide medical and surgical treatment to pregnant women and to mother and baby following delivery 19.10.07 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 19.10.08 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 19.10.09 Oncology - Nurses in this specialty provide care and support for patients diagnosed with cancer 19.10.10 Palliative Care - Nurses in this specialty provide sensitive care and pain relief to patients in the final stages of life. 19.10.11 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 19.10.12 Public Health - Nurses in this specialty provide population-based community services 19.10.13 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 19.10.14 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 19.10.15 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 19.10.16 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 19.10.17 Women's Health - Nurses in this specialty provided care for women across the life cycle with emphasis on conditions that are particular to women 19.11 NPI (National Provider ID @ unit level) 49 - This number will provide a unique national provider number to every Medicare health care provider 19.11.01 Yes 19.11.02 No LOINC Coding LOINC Code NMMDS Component Answer ID NMMDS Code 76354-0 Licensed nurse demographics per unit or service panel Panel 19 76355-7 Employment position panel [NMMDS] Panel 19.01 76356-5 Nurse employment position Provider [NMMDS] LL3212-9 76353-2 Licensed nursing personnel # 76357-3 Licensed nursing personnel.employment position [NMMDS] # Licensed nursing personnel.employment 76358-1 position/ Licensed nursing personnel.nursing unit % 76359-9 Licensed nursing personnel and sex panel [NMMDS] Panel 19.02 76661-8 Sex of Provider [NMMDS] LL3275-6 76353-2 Licensed nursing personnel [NMMDS] # 76360-7 Licensed nursing personnel.sex[nmmds] # 76361-5 Licensed nursing personnel.sex/ Licensed nursing personnel.nursing unit [NMMDS] % 76362-3 Race or ethnicity panel [NMMDS] Panel 19.03 76663-4 Race or ethnicity of Provider [NMMDS] LL3276-4 76353-2 Licensed nursing personnel # [NMMDS] # 76363-1 Licensed nursing personel.race or ethnicity # [NMMDS] #

58 Licensed nursing personel.race or ethnicity/ 76364-9 Licensed nursing personnel.nursing unit [NMMDS] % 76365-6 Age category panel [NMMDS] Panel 19.04 76366-4 Nurse age range Provider [NMMDS] LL3213-7 76353-2 Licensed nursing personnel # [NMMDS] # 76367-2 Licensed nursing personnel.age range # [NMMDS] # 76368-0 Licensed nursing personnel.age range/ Licensed nursing personnel.nursing unit [NMMD] % 76369-8 Entry level nursing degree panel [NMMDS] Panel 19.05 76370-6 Entry level nursing degree Provider [NMMDS] LL3215-2 76353-2 Licensed nursing personnel # [NMMDS] # 76371-4 Licensed nursing personnel.entry level nursing degree # [NMMDS] # 76372-2 Licensed nursing personnel.entry level nursing degree/ Licensed nursing personnel.n % 76373-0 Highest level of education in a nursing degree panel [NMMDS] Panel 19.06 76374-8 Highest level of education in a nursing degree Provider [NMMDS] LL3215-2 76353-2 Licensed nursing personnel # [NMMDS] {#} # 76375-5 Licensed nursing personnel.highest level of education in a nursing degree # [NMMDS] # 76376-3 Licensed nursing personnel.highest level of education in a nursing degree/ Licensed % 76377-1 Highest level of education in non-nursing degree panel [NMMDS] Panel 19.07 76378-9 Highest level of education in a non-nursing degree Provider [NMMDS] LL3216-0 76353-2 Licensed nursing personnel # [NMMDS] # 76379-7 Licensed nursing personnel.highest level of education in a non-nursing degree # [NMMDS] # Licensed nursing personnel.highest level of 76380-5 education in a non-nursing degree/ Licensed.nursing unit [NMMDS] % 76381-3 Nursing license type panel [NMMDS] Panel 19.08 76382-1 Primary nursing license type Provider [NMMDS] LL3214-5 76353-2 Licensed nursing personnel # [NMMDS] # 76383-9 Licensed nursing personnel.primary nursing license type # [NMMDS] #

59 Licensed nursing personnel.primary nursing 76384-7 license type/licensed nursing personnel.nursing unit % 76385-4 Nursing certification panel [NMMDS] Panel 19.09 76386-2 Nursing certification Provider [NMMDS] LL3218-6 76353-2 Licensed nursing personnel # [NMMDS] {#} # 76387-0 Licensed nursing personnel.nursing certification # [NMMDS] # Licensed nursing personnel.nursing 76388-8 certification/ Licensed nursing personnel.nursing unit [NMMDS] % 76389-6 Employment specialty panel [NMMDS] Panel 19.10 76390-4 Nurse employment specialty Provider [NMMDS] LL3219-4 76353-2 Licensed nursing personnel # [NMMDS] # 76391-2 Licensed nursing personnel.employment specialty # [NMMDS] # 76392-0 Licensed nursing personnel [NMMDS] % 76393-8 National provider indentifier panel [NMMDS] Panel 19.11 76398-7 Provider has a national provider ID LL361-7 76394-6 Registered nurse personnel # [NMMDS] # 76395-3 Registered nurse personnel.national provider ID # [NMMDS] # Registered nurse personnel.national provider 76396-1 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 51-54. 1. 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 20.01 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 20.01.01 Knowledge required Level 1 - Knowledge of simple routine or repetitive tasks or operations that require little or no previous training or experience 20.01.01.01 Knowledge required Level 1-1 - Knowledge of basic or commonly used rules, procedures, or operations that requires some previous training or experience 20.01.02.02 Knowledge required Level 2-2 - Knowledge of basic or commonly used nursing procedures which are reflected in licensure followed by training as a practical nurse or vocational nurse 20.01.03.01 Knowledge required Level 3-1 - 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. 20.01.03.02 Knowledge required Level 3-2 - 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. 20.01.04.01 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 20.01.04.02 Knowledge required Level 4-2 - A knowledge of nursing comparable to that acquired through completion of a two year college level program in nursing. 20.01.05 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. 20.01.06 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. 20.01.07 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. 20.01.08 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. 20.01.09 Knowledge required Level 9 - Mastery of the profession of nursing to generate new hypotheses and develop new theories; or equivalent knowledge. 20.02 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. 20.02.01 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 20.02.02 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. 20.02.03 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. 20.02.04 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. 20.02.05 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. 20.02.06 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. 20.03 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. 50 20.03.01 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. 20.03.01.01 Time load level 1 - Often have spare time. Interruptions or overlap among activities occur infrequently or not at all. 20.03.01.02 Time load level 2 - Occasionally have spare time. Interruptions or overlap among activities occur frequently.

63 LOINC Coding 20.03.01.03 Time load level 3 - Almost never have spare time. Interruptions or overlap among activities are frequent or occur all the time. 20.03.02 Mental Effort - The amount of attention or concentration that is required to perform a task 20.03.02.01 Mental effort load level 1 - Very little conscious mental effort or concentration required. Activity is almost automatic, requiring little or no attention. 20.03.02.02 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 20.03.02.03 Mental effort load level 3 - Extensive mental effort and concentration are necessary. Very complex activity requiring total attention. 20.03.03 Psychological Stress Load - The presence of confusion, frustration, and/or anxiety associated with task performance 20.03.03.01 Psychological stress load level 1 - Little confusion, risk, frustration, or anxiety exists and can be easily accommodated. 20.03.03.02 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. 20.03.03.03 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 77221-0 Clinical knowledge, decision making, and 20 mental workload panel [NMMDS]

64 57120-8 Type of nursing provider [NMMDS] 77222-8 Knowledge required level [NMMDS] 20.01 77223-6 Nursing staff.knowledge required level/ % Nursing staff [NMMDS] 77224-4 Decision making required level [NMMDS] 20.02 77225-1 Nursing staff.decision making required % level/nursing staff [NMMDS] 77226-9 Workload dimensions panel [NMMDS] 20.03 77227-7 Time load level [NMMDS] 20.03.01 77228-5 Nursing staff.time load level/nursing staff % [NMMDS] 77229-3 Mental effort load level [NMMDS] 20.03.02 77230-1 Nursing staff.mental effort load level/ % Nursing staff [NMMDS] 77231-9 Psychological stress load level [NMMDS] 20.03.03 77232-7 Nursing staff.psychological stress load level/ Nursing staff [NMMDS] % LOINC Answer List 57120-8 Type of nursing provider [NMMDS] Normative List LL767-5 Sequence # NMMDS Component Answer ID NMMDS Code 1 APN LA12063-6 01 2 RN LA6367-2 02 3 LPN/ LVN LA12071-9 03 4 UAP LA12085-9 04 5 Total nursing personnel LA12083-4 05 77222-8 Knowledge required level [NMMDS] Normative list LL3587-4 Sequence # NMMDS Component Answer ID NMMDS Code 1 Knowledge required Level 1 LA23736-4 20.01.01 2 Knowledge required Level 2-1 LA23737-2 20.01.02 3 Knowledge required Level 2-2 LA23738-0 20.01.03 4 Knowledge required Level 3-1 LA23739-8 20.01.04 5 Knowledge required Level 3-2 LA23740-6 20.01.05 6 Knowledge required Level 4-1 LA23741-4 20.01.06 7 Knowledge required Level 4-2 LA23742-2 20.01.07 8 Knowledge required Level 5 LA23743-0 20.01.08 9 Knowledge required Level 6 LA23744-8 20.01.09 10 Knowledge required Level 7 LA23745-5 20.01.10 11 Knowledge required Level 8 LA23746-3 20.01.11 12 Knowledge required Level 9 LA23747-1 20.01.12

65 77224-4 Decision making required level [NMMDS] Normative list LL3586-6 Sequence # NMMDS Component Answer ID NMMDS Code 1 Decision-making required level 1 LA23748-9 20.02.01 2 Decision-making required level 2 LA23749-7 20.02.02 3 Decision-making required level 3 LA23750-5 20.02.03 4 Decision-making required level 4 LA23751-3 20.02.04 5 Decision-making required level 5 LA23752-1 20.02.05 6 Decision-making required level 6 LA23753-9 20.02.06 77227-7 Time load level [NMMDS] Normative list LL3585-8 Sequence # NMMDS Component Answer ID NMMDS Code 1 Time load level 1 LA23754-7 20.03.01.01 2 Time load level 2 LA23755-4 20.03.01.02 3 Time load level 3 LA23756-2 20.03.01.03 77229-3 Mental effort load level [NMMDS] Normative list LL3588-2 Sequence # NMMDS Component Answer ID NMMDS Code 1 Mental effort load level 1 LA23757-0 20.03.02.01 2 Mental effort load level 2 LA23758-8 20.03.02.02 3 Mental effort load level 3 LA23759-6 20.03.02.03 77231-9 Psychological stress load level [NMMDS] Normative list LL3584-1 Sequence # NMMDS Component Answer ID NMMDS Code 1 Psychological stress load level 1 LA23760-4 20.03.03.01 2 Psychological stress load level 2 LA23761-2 20.03.03.02 3 Psychological stress load level 3 LA23762-0 20.03.03.03 21 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 55-57.

LOINC Coding 21.01.01 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. 21.01.02 Cultural Factors Frequency 21.02.01 Psychosocial Factors - Episodes in which nurses have experienced verbal assaults, physical violence, and/or feelings of conflict or friction with coworkers, particularly physicians. 21.02.02 Psychosocial Factors Frequency 21.03.01 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. 21.03.02 Physical Factors Frequency LOINC Code NMMDS Component Answer ID NMMDS Code 75330-1 NMMDS environmental condition panel 75331-9 Total number of staff completing the # environmental conditions survey [NMMDS] 75332-7 To what extent do you agree or disagree with LL2995-0 21.01.01 cultural factors contributing to the phenomenon of complexity? 75333-5 Within the last month, how often have you LL2996-8 21.01.02 experienced cultural factors? 75334-3 To what extent do you agree or disagree with LL2995-0 21.02.01 psychosocial factors contributing to the phenomenon of complexity? 75335-0 Within the last month, how often have you LL2712-9 21.02.02 experienced psychosocial factors? 75336-8 To what extent do you agree or disagree with LL2995-0 21.03.01 physical factors contributing to the phenomenon of complexity? 75337-6 Within the last month, how often have you experienced physical factors? LL2712-9 21.03.02 66

67 LOINC Answer List Normative answer list LL2995-0, LL2712-9 Sequence # NMMDS Component Answer ID NMMDS Code 1 Strongly disagree LA15236-5 1 2 Disagree LA15773-7 2 3 Somewhat disagree LA15234-0 3 4 Somewhat agree LA15235-7 4 5 Agree LA15774-5 5 6 Strongly agree LA15237-3 6 Normative answer list LL2996-8 Sequence # NMMDS Component Answer ID NMMDS Code 1 Rarely/Never LA21376-1 1 2 Sometimes LA10082-8 2 3 Often LA10044-8 3 4 Almost always/always LA21377-9 4 22 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. 22.01 Stage 0 - All three ancillaries not installed (laboratory, pharmacy, and radiology) 22.02 Stage 1 - Ancillaries - Lab, Rad, and Pharmacy - all installed 22.03 Stage 2 - Clinical Data Repository (CDR), Controlled Medical Vocabulary, Clinical Decision Support (CDS), may have Document Imaging; Health Information Exchange (HIE) capable 22.04 Stage 3 - Nursing/clinical documentation (flow sheets), CDSS (error checking), Picture Archive and Communication Systems (PACS) available outside Radiology

68 22.05 Stage 4 - Computerized Practitioner Order Entry (CPOE), Clinical Decision Support (clinical protocols) 22.06 Stage 5 - The closed loop medication administration with bar coded unit dose medications environment is fully implemented 22.07 Stage 6 - Physician documentation (structured templates), full CDSS (variance & compliance), full Radiology-PACS 22.08 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 75744-3 Electronic health record implementation stage Panel 22 panel 75745-0 Electronic health record implementation stage 75745-0 Electronic Health Record (EHR) Implementation Stage [NMMDS] - LOINC Answer List Normative answer list LL3104-8 Sequence # NMMDS Component Answer ID NMMDS code 1 Stage 0 - All three ancillaries not installed LA21931-22.01 (laboratory, pharmacy, and radiology) 3 2 Stage 1 - Ancillaries - Lab, Rad, Pharmacy - all LA21932-22.02 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 LA21933-9 22.03 4 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 LA21934-7 LA21935-4 LA21936-2 22.04 22.05 22.06

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 LA21937-0 LA21938-8 22.07 22.08

70 REFERENCES 1. Simpson RL. Technology: Nursing the system. A nursing management minimum data set. Nurs Manage. 1993;24(4):24-25. 2. Huber D, Schumacher L, Delaney C. Nursing management minimum data set (NMMDS). J Nurs Adm. 1997;27(4):42-48. 3. Delaney C, Huber D, eds. Nursing management minimum data set (NMMDS). Chicago, IL: The American Organization of Nurse Executives; 1996. 4. United States Department of Health and Human Services. Consolidated health informatics initiative. Final recommendation information sheet. 2003. 5. Academy Health. Glossary of terms commonly used in health care. 2004. 6. American Disability Act (ADA). Individual identifier payer. 2004. 7. U.S. Department of Education. Archived information: Glossary. 8. American Nurses Association (ANA). Genetics/genomics nursing: Scope and standards of practice. Silver Spring, MD: ANA; 2007. 9. American Nurses Association (ANA). Hospice and palliative nursing: Scope and standards of practice. Silver Spring, MD: ANA; 2007. 10. American Nurses Association (ANA). Cardiovascular nursing: Scope and standards of practice. Silver Spring, MD: ANA; 2008. 11. American Nurses Association (ANA). Public health nursing: Scope and standards of practice. Silver Spring, MD: ANA; 2007. 12. National Database of Nursing Quality Indicators. Patient days indicator 2009. 2009. 13. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National public health performance standards program, acronyms, glossary, and references terms. 2011. 14. American Nurses Credentialing Center. Demographic information form (DIF) instructions. 2008. 15. National Quality Forum. National voluntary consensus standards for nursing-sensitive care performance measure set maintenance. 2009.

16. American Nurses Credentialing Center. Application manual: Magnet recognition program. 2008. 17. Wolf GA, Greenhouse PK. Blueprint for design: Creating models that direct change. J Nurs Adm. 2007;37(9):381-387. 18. Makinen A, Kivimaki M, Elovainio M, Virtanen M, Bond S. Organization of nursing care as a determinant of job satisfaction among hospital nurses. J Nurs Manag. 2003;11(5):299-306. 19. Minnick AF, Mion LC, Johnson ME, Catrambone C. How unit level nursing responsibilities are structured in US hospitals. J Nurs Adm. 2007;37(10):452-458. 20. Seago JA. Nurse staffing, models of care delivery, and interventions. In: Shojania KG, Duncan BW, McDonald KM, Wachter RM, ed. Making health care safer: A critical analysis of patient safety practices; 2001:Chapter 39. http://www.ahrq.gov/clinic/ptsafety/chap39.htm. 21. Tiedeman ME, Lookinland S. Traditional models of care delivery: What have we learned? J Nurs Adm. 2004;34(6):291-297. 22. American Nurses Credentialing Center (ANCC). Nursing case management catalog. 1998. 23. Huber DL, Hall JA, Vaughn T. Dose of case management interventions. Lippincotts Case Manag. 2001;6(3):119-126. 24. American Nurses Association (ANA). Scope and standards of gerontological nursing practice. 2nd ed. Washington, DC: ANA; 2001. 25. APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Consensus model for APRN regulation: Licensure, accreditation, certification & education. 2008. 26. Centers for Medicare & Medicaid Services (CMS). Glossary. http://www.cms.gov/apps/glossary/default.asp?letter=a&language=english. Updated 2006. 27. American Nurses Association (ANA). Consensus model for advanced practice registered nurse (APRN) regulation. 2009. 28. The Joint Commission. The joint commission accreditation programs. http://www.jointcommission.org/accreditation/accreditation_main.aspx. Updated 2013. 29. Accreditation Association for Ambulatory Health Care (AAAHC). Accreditation association for ambulatory health care (AAAHC) accreditation programs. http://www.aaahc.org/en/accreditation/. Updated 2013. 71

72 30. Accreditation Commission for Health Care, Inc. (ACHC). Accreditation commission for health care, inc. (ACHC) accreditation programs. http://www.achc.org/programs. Updated 2013. 31. American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). American association for accreditation of ambulatory surgery facilities (AAAASF) accreditation programs. http://www.aaaasf.org/pub/site/standards.html. Updated 2013. 32. American Osteopathic Association (AOA). American osteopathic association (AOA) accreditation programs. http://www.osteopathic.org/inside-aoa/accreditation/pages/default.aspx. Updated 2013. 33. Healthcare Facilities Accreditation Program (HFAP). Healthcare facilities accreditation program (HFAP) accreditation programs. http://www.hfap.org/accreditationprograms/acute.aspx. Updated 2013. 34. Community Health Accreditation Program (CHAP). Community health accreditation program (CHAP) accreditation programs. http://www.chapinc.org/accreditation. Updated 2013. 35. DNV Healthcare (DNVHC). DNV healthcare (DNVHC) accreditation programs. http://dnvaccreditation.com/pr/dnv/default.aspx. Updated 2013. 36. The Joint Commission. Implementation guide for NQF endorsed nursing sensitive care performance measures. Oakbrook Terrace, Illinois: Joint Commission; 2006. 37. Hofmann PB. Accurate measurement of nursing turnover: The first step in its reduction. J Nurs Adm. 1981;11(11-12):37-39. 38. Hackman J OR. Work Redesign. Addison-Wesley; 1980. 39. Hackman J RO. Development of the job satisfaction Survey. Journal of Applied Psychology. 1975;60(2):159-170. 40. The Forum of State Nursing Workforce Centers. National nursing workforce minimum datasets. http://www.nursingworforcecenters.org/minimumdatasets.aspx. Updated 2009. 41. National Council of State Boards of Nursing. Definitions of nursing terms. https://www.ncsbn.org/2731.htm. Updated 2012. 42. American Academy of Nurse Practitioners (AANP). http://www.aanp.org/nr/rdonlyres/ea7163f5-0429-4214-aebb- DF1A0447BFFF/0/FactSheetNPI109.pdf. Updated 2005.

73 43. Merriam Webster Online Dictionary. Gender. http://www.merriamwebster.com/dictionary/gender?show=0&t=1328067049. Updated 2012. 44. Merriam Webster Online Dictionary. Race. http://www.merriamwebster.com/dictionary/race. Updated 2012. 45. American Nurses Credentialing Center (ANCC). ANCC acreditation center. http://www.nursecredentialing.org/certification.aspx. Updated 2012. 46. Wound Ostomy and Continence Nursing Certification Board (WOCNCB). http://www.wocncb.org/about/accreditation.php. Updated 2012. 47. American Midwifery Certification Board (AMCB). American midwifery certification board (AMCB). http://www.amcbmidwife.org/. Updated 2012. 48. Advance Healthcare Network. A new definition for nursing informatics by susan K newbold. http://nursing.advanceweb.com/article/a-new-definition-for-nursing-informatics.aspx. Updated 2012. 49. Centers for Medicaid and Medicare Services (CMS). Unique physician identification number (UPIN) directory. http://www.cms.gov/research-statistics-data-and-systems/files-for- Order/NonIdentifiableDataFiles/UniquePhysicianIdentificationDirectory.html. Updated 2012. 50. Reid GB, Potter SS, Bressler JR. Subjective workload assessment technique (SWAT): A user s guide. [Armstrong Aerospace Medical Research Laboratory Technical Report (AAMRL_TR_89-023)]. 1989. 51. U.S. Office of Personnel Management. Position classification standards for nurse series, GS- 0610, TS-8. 1977. 52. U.S. Office of Personnel Management. Position classification standard for practical nurse series, GS-0620, TS-69. 1983. 53. U.S. Office of Personnel Management. Position classification standards for nursing assistant series, GS-0621, TS-55 August 1981, TS-69. 1983. 54. U.S. Office of Personnel Management. Introduction to the position classification standards TS-134 July 1995, TS-107. 1991. 55. Clancy TR, Effken JA, Pesut D. Applications of complex systems theory in nursing education, research, and practice. Nurs Outlook. 2008;56(5):248-256.e3.

74 56. Krichbaum K, Diemert C, Jacox L, et al. Complexity compression: Nurses under fire. Nurs Forum. 2007;42(2):86-94. 57. Krichbaum KE, Peden-McAlpine C, Diemert C, Koenig P, Mueller C, Savik K. Designing a measure of complexity compression in registered nurses. West J Nurs Res. 2011;33(1):7-25. 58. HIMSS Analytics. Electronic medical record adoption model (EMRAM). http://www.himssanalytics.org/emram/emram.aspx. Updated 2013.

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 2013 2014 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 15.11 Medicare 15.1101 Medicaid 15.1102 Public Health Service (PHS) 15.1103 PHS-Indian

76 15.1104 Military Health System (TRICARE) 15.1105 Dept. of Justice 15.1106 State Employer 15.1107 State Health Service 15.1108 Non-government 15.12 Health Maintenance Organization (HMO) 15.1201 Preferred Provider Organization (PPO) 15.1202 Discount Fee-for- Service 15.1203 Commercial Insurance 15.1204 Workers Compensation

77 15.1205 Industrial 15.1206 Trust Accounts 15.1207 Self Pay 15.1208 Indigent 15.1209 Charity 15.1210 Multi-Method 15.13 Non-patient Revenue Generation 15.14

78 15.2 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 15.21 Medicare 15.2101 Medicaid 15.2102 Public Health Service (PHS) 15.2103 PHS-Indian 15.2104 Military Health System (TRICARE) 15.2105 Dept. of Justice 15.2106 State Employer 15.2107 State Health Service 15.2108

79 Non-government 15.22 Health Maintenance Organization (HMO) 15.2201 Preferred Provider Organization (PPO) 15.2202 Discount Fee-for- Service 15.2203 Commercial Insurance 15.2204 Workers Compensation 15.2205 Industrial 15.2206 Trust Accounts 15.2207 Self Pay 15.2208 Indigent 15.2209 Charity

80 15.2210 Multi-Method 15.23 Non-patient Revenue Generation 15.24

81 15.3 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 15.31 Medicare 15.3101 Medicaid 15.3102 Public Health Service (PHS) 15.3103 PHS-Indian 15.3104 Military Health System (TRICARE) 15.3105 Dept. of Justice 15.3106 State Employer 15.317 State Health Service

82 15.3108 Non-government 15.32 Health Maintenance Organization (HMO) 15.3201 Preferred Provider Organization (PPO) 15.3202 Discount Fee-for- Service 15.3203 Commercial Insurance 15.3204 Workers Compensation 15.3205 Industrial 15.3206 Trust Accounts 15.3207 Self Pay 15.3208 Indigent 15.3209

83 Charity 15.3210 Multi-Method 15.33 Non-patient Revenue Generation 15.34

84 15.4 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 15.41 Medicare 15.4101 Medicaid 15.4102 Public Health Service (PHS) 15.4103 PHS-Indian 15.4104 Military Health System (TRICARE) 15.4105 Dept. of Justice 15.4106 State Employer 15.4107 State Health Service

85 15.4108 Non-government 15.42 Health Maintenance Organization (HMO) 15.4201 Preferred Provider Organization (PPO) 15.4202 Discount Fee-for- Service 15.4203 Commercial Insurance 15.4204 Workers Compensation 15.4205 Industrial 15.4206 Trust Accounts 15.4207 Self Pay 15.4208 Indigent 15.4209

86 Charity 15.4210 Multi-Method 15.43 Non-patient Revenue Generation 15.44

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 16.11 Discounted fee for service 16.12 Per diem 16.13 Diagnosis Related Group (DRG) 16.14 All Payer Group (APG) 16.15 Per visit 16.16 Per member/month 16.17 16.2 Total Organization Identify the percentage distribution of reimbursement received for the total organization.

88 Payment Basis % Services Delivered % Revenue Fee for service 16.21 Discounted fee for service 16.22 Per diem 16.23 Diagnosis Related Group (DRG) 16.24 All Payer Group (APG) 16.25 Per visit 16.26 Per member/month 16.27

89 16.3 Total Nursing Department Identify the percentage distribution of reimbursement received for the total nursing department. Payment Basis % Services Delivered % Revenue Fee for service 16.31 Discounted fee for service 16.32 Per diem 16.33 Diagnosis Related Group (DRG) 16.34 All Payer Group (APG) 16.35 Per visit 16.36 Per member/month 16.37 16.4 Nursing Delivery Unit/Service Identify the percentage distribution of reimbursement received for the nursing delivery unit/service.

90 Payment Basis % Services Delivered % Revenue Fee for service 16.41 Discounted fee for service 16.42 Per diem 16.43 Diagnosis Related Group (DRG) 16.44 All Payer Group (APG) 16.45 Per visit 16.46 Per member/month 16.47

91 17 Nursing Delivery Unit/Service Budget 17.1 Costs 17.11 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) 17.111 Salaries per year 17.112 Benefits 17.113 Depreciation 17.114 Supplies 17.115 Other operating expenses 17.119 System s Planned Budget System s Actual Budget

92 17.12 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) 17.121 Salaries per year 17.122 Benefits 17.123 Depreciation 17.124 Supplies 17.125 Other operating expenses 17.129 Organization s Planned Budget Organization s Actual Budget

93 17.13 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 17.131 Salaries 17.132 Benefits 17.133 Depreciation 17.134 Supplies 17.135 Other operating expenses 17.139 Nursing Department s Planned Budget Nursing Department s Actual Budget

94 17.2 Revenues 17.21 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 17.211 System s Planned Budget System s Actual Budget 17.22 Nursing Department - Organization Identify the planned and actual nursing department revenue as a percentage of the organization s annual revenues. Nursing Department Revenue Revenue 17.221 Organization s Planned Budget Organization s Actual Budget 17.23 Nursing Delivery Unit/Service - Nursing Department

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 17.231 Nursing Department s Planned Budget Nursing Department s Actual Budget

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. 18.11 Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year. 18.12 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. 18.13 18.2 Nursing Department - Organization

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. 18.21 Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year. 18.22 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. 18.23

98 18.3 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. 18.31 Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year. 18.32 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. 18.33

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, 1996. 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. 176-9. 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. 32-8. Huber D, and Delaney CW. The Nursing Management Minimum Data Set (NMMDS): Data Elements. Unpublished manuscript, 2005. Huber D, Schumacher L, and Delaney C. Nursing Management Minimum Data Set (NMMDS). Journal of Nursing Administration 1997: 27(4): 42-8. 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): 164-5. Jones J, Newsom ET, and Delaney C. Use of nursing management minimum data set (nmmds) for a focused information retrieval. San Diego: CA ed., 2009. 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), 134-41. 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. 1148. 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): 336-43.